Midwives' perspectives regarding episiotomy practice in Kurdistan region/Iraq

Abstract

IntroductionAn episiotomy is a surgical incision made into the perineum, which if required should only be performed immediately prior to birth to enlarge the vaginal outlet and to assist the birth of the baby.1 The reason for using episiotomy depends on the need to minimize the risks of severe spontaneous maternal trauma and fetal comprise. Performing episiotomy has undergone a number of revisions starting from 1920s when routine episiotomy was advocated to the 1980s when restrictive use of episiotomy became the recommended practice.3 There is no evidence to support the use of routine episiotomy in any circumstance, not even when there has been a previous third-degree tear. 1The World Health Organization also supports the restricted use of episiotomy (less than 20%) as there is no evidence that routine episiotomy decreases perineal damage. 4 Australian research has shown a high prevalence of maternal health problems up to six months after birth, with one or more health problems reported by 94% of women. Painful perineum (21%) and sexual problems (26.3%) were two of the most commonly cited. These problems were especially relevant to primiparous women and to women who had an episiotomy and/or instrumental birth. 5Episiotomy rates widely vary between countries, institutions, and individuals because of differences in attitudes and training.6 Wide practice variation in rate Background and objective: Local professional norms, experiences in tainting, and individual provider preference may lead to wide practice variation in rate and practice of episiotomy by midwives. The aim of this study was to find out the midwives' perspectives regarding practicing of episiotomy in three main cities of Kurdistan region/Iraq. Methods: A cross-sectional, descriptive study was conducted on 53 midwives working in delivery room in three maternity teaching hospitals in the three biggest cities of Kurdistan Region of Iraq. A questionnaire was constructed for the purpose of the study and data were collected by interview with midwives. F test and Chi-square test were used for analyzing the data. Results:The majority (88.7%) of midwives thought that the rate of episiotomy were high in their hospitals that were attributed to five factors; maternal (77.35%), fetal (39.62%), midwives (37.73%), obstetricians (30.18%) and hospital policy and health system (20.75%). The opinion of midwives regarding how to decrease the rate of episiotomy included improving midwifery care during delivery (77.35%), reforming health system (60.37%), reforming hospital policy (50.94%) and improving maternal care during pregnancy (26.41%). Conclusion: Taking into consideration the midwives' perspectives and views regarding episiotomy and providing training courses may help in decreasing the rate of episiotomy and its practice in correct way in Kurdistan's maternity hospitals.

The perception and knowledge about episiotomy: A cross-sectional survey involving healthcare workers in a low- and middle-income country

“… 2 These variations in rates seen worldwide clearly indicate that episiotomy is heavily driven by professional norms, different experiences in training and individual provider preference and not by physiological necessity. 3 , 4 These differences could also result from varying personal opinions regarding the benefits of episiotomy and an inconsistency in their acquaintance with the reports from the literature. A Cochrane review has found that a selective episiotomy policy has more benefits compared to routine episiotomy use.…”